Abstract

Background Socio-economic disparities in nutrition are well documented. This study tested the hypothesis that socio-economic differences
in nutrient intakes can be accounted for, in part, by diet cost.

Methods A representative sample of 1295 adults in King County (WA) was surveyed in 2008–2009, and usual dietary intakes were assessed
based on a food-frequency questionnaire. The monetary value of individual diets was estimated using local retail supermarket
prices for 384 foods. Nutrients of concern as identified by the 2005 Dietary Guidelines Advisory Committee were fibre, vitamins
A, C and E, calcium, magnesium and potassium. A nutrient density score based on all seven nutrients was another dependent
measure. General linear models and linear regressions were used to examine associations among education and income, nutrient
density measure and diet cost. Analyses were conducted in 2009–2010.

Results Controlling for energy and other covariates, higher-cost diets were significantly higher in all seven nutrients and in overall
nutrient density. Higher education and income were positively and significantly associated with the nutrient density measure,
but these effects were greatly attenuated with the inclusion of the cost variable in the model.

Conclusions Socio-economic differences in nutrient intake can be substantially explained by the monetary cost of the diet. The higher
cost of more nutritious diets may contribute to socio-economic disparities in health and should be taken into account in the
formulation of nutrition and public health policy.